Evaluation of the Long-Term Impact on Quality After the End of Pharmacist-Driven Warfarin Therapy Management in Patients With Poor Quality of Anticoagulation Therapy

Author(s):Show less -

Marcatto, Leiliane Rodrigues ^[1] ; Sacilotto, Luciana ^[2] ; Tavares, Leticia Camargo ^[1] ; Pereira Souza, Debora Stephanie ^[3] ; Olivetti, Natalia ^[2] ; Cassaro Strunz, Celia Maria ^[4] ; Costa Darrieux, Francisco Carlos ^[2] ; Scanavacca, Mauricio Ibrahim ^[2] ; Krieger, Jose Eduardo ^[1] ; Pereira, Alexandre Costa ^[1] ; Lima Santos, Paulo Caleb Junior ^[3]

Affiliation

^[1] Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Med, Inst Coracao, HCFMUSP, Lab Genet & Mol Cardiol, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Med, Inst Coracao, Arrhythmia Unit, HCFMUSP, Sao Paulo - Brazil

^[3] Univ Fed Sao Paulo, Dept Pharmacol, EPM Unifesp, Escola Paulista Med, Sao Paulo - Brazil

^[4] Umiversidade Sao Paulo, Hosp Clin HCFMUSP, Inst Coracao, Clin Lab, Fac Med, HCFMUSP, Sao Paulo - Brazil

• Document type: Journal article
• Source: FRONTIERS IN PHARMACOLOGY; v. 11, JUL 14 2020.
• Web of Science Citations: 0

Abstract

Background Warfarin is the most common oral anticoagulant drug, especially in low-income and emerging countries, because of the high cost of direct oral anticoagulant (DOACs), or when warfarin is the only proven therapy (mechanical prosthetic valve and kidney dysfunction). The quality of warfarin therapy is directly associated with dose management. Evidence shows that pharmaceutical care achieves a better quality of therapy with warfarin. However, there are no studies showing this intervention in a specific patient group with poor quality of anticoagulation in a long period after the end of the follow-up by a pharmacist. Thus, the aim of this study was to evaluate whether the quality of warfarin therapy driven by a pharmacist remains stable in the long term after the end of follow up with a pharmacist, in AF patients with poor quality of anticoagulation. Methods This is a prospective study, which evaluated about 2,620 patients and selected 262 patients with AF and poor quality of anticoagulation therapy with warfarin (TTR<50% - based on the last three values of international normalized ratio). Pharmacist-driven therapy management was performed up to 12 weeks. Data from patients were evaluated 1 year after the end of the follow-up with pharmacist. Results Comparison between mean TTR after 12 weeks of pharmaceutical care (54.1%) and mean TTR one year after the end of the pharmaceutical care (56.5%; p=0.081) did not achieve statistical difference, demonstrating that the increment of quality due to intervention of 12 weeks was maintained for 1 year after intervention. Conclusion The long-term impact of pharmaceutical care was beneficial for patients with AF and poor quality of warfarin anticoagulation. This design might be an important strategy to treat a subgroup of patients without proven effectiveness of warfarin. (AU)

• FAPESP's process: 16/23454-5 - Evaluation of a pharmacogenetic-based warfarin dosing algorithm in patients without stable dose
• Grantee: Leiliane Rodrigues Marcatto
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 16/22507-8 - Impact assessment of the inclusion of ABCB1 and CYP4F2 genes polymorphisms in pharmacogenetic-guided algorithm for personalized warfarin dosing
• Grantee: Letícia Camargo Tavares
• Support Opportunities: Scholarships in Brazil - Master
• FAPESP's process: 13/09295-3 - Pharmacogenetic of cardiovascular system drugs focusing on implementation
• Grantee: Paulo Caleb Júnior de Lima Santos
• Support Opportunities: Research Grants - Young Investigators Grants
• FAPESP's process: 19/08338-7 - Pharmacogenomics: implementation and cost-effectiveness evaluation
• Grantee: Paulo Caleb Júnior de Lima Santos
• Support Opportunities: Regular Research Grants